Title
Fibrinolytic shut-down after surgery: Impairment of the balance between tissue-type plasminogen activator and its specific inhibitor
Author
D'Angelo, A.
Kluft, C.
Verheijen, J.H.
Gaubius Instituut TNO
Publication year
1985
Abstract
In nine patients with non-malignant diseases undergoing major upper abdominal surgery, the mechanism of the postoperative fibrinolytic shut-down was investigated because of its potential significance for postoperative deep vein thrombosis by employing new and specific methods for assessing and stimulating the fibrinolytic system. The shut-down was found to result from an impairment of the balance between tissue-type plasminogen activator, t-PA, and its recently discovered fast-acting inhibitor. In this balance, the t-PA antigen concentrations both in resting conditions and after stimulation evoked by desamino-D-arginine vasopressin (DDAVP) were found to be unchanged by surgery. However, there was a significant postoperative increase in t-PA inhibitor levels. The release of t-PA under the stimulus of DDAVP infusion overcame the postoperative shut-down of t-PA activity. However, DDAVP infusion was associated with potentially unfavourable increases in the Factor VIII/von Willebrand factor complex. The discovery of increased t-PA inhibitor in the postoperative period opens new possibilities for a rational approach to reduce or abolish the postoperative fibrinolytic shut-down. Chemicals/CAS: blood clotting factor 8, 9001-27-8; desmopressin, 16679-58-6; plasminogen activator inhibitor, 105844-41-5; tissue plasminogen activator, 105913-11-9; Desmopressin, 16679-58-6; Factor VIII, 9001-27-8; Glycoproteins; Plasminogen Inactivators; Tissue Plasminogen Activator, EC 3.4.21.68; von Willebrand Factor
Subject
Biology
blood clotting factor 8
plasminogen activator inhibitor
blood and hemopoietic system
blood clotting disorder
clinical article
diagnosis
etiology
peripheral vascular system
postoperative thrombosis
Adult
Aged
Desmopressin
Factor VIII
Female
Fibrinolysis
Glycoproteins
Human
Male
Middle Age
Plasminogen Inactivators
Postoperative Complications
Support, Non-U.S. Gov't
Tissue Plasminogen Activator
von Willebrand Factor
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TNO identifier
229925
ISSN
0014-2972
Source
European Journal of Clinical Investigation, 15 (6), 308-312
Document type
article